Provider Demographics
NPI:1891892709
Name:DEPOE, ADAM T (OD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:T
Last Name:DEPOE
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Gender:M
Credentials:OD
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Mailing Address - Street 1:550 EAGLES LANDING PARKWAY
Mailing Address - Street 2:STE 208
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-474-1237
Mailing Address - Fax:770-474-5224
Practice Address - Street 1:681 SOUTH EIGHT STREET
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-228-2020
Practice Address - Fax:770-228-2020
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-03-05
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Provider Licenses
StateLicense IDTaxonomies
GAOPT001305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist